Chirurgisches Management des renalen Hyperparathyreoidismus

Zusammenfassung

Das konservative Konzept zur Therapie des renalen Hyperparathyreoidismus hat sich durch neue Medikamente, insbesondere durch die Kalzimimetika gewandelt. In der Folge wurde vielfach über einen Rückgang der Operationsfrequenz bei renalem Hyperparathyreoidismus berichtet. Vor diesem Hintergrund müssen die Rolle der chirurgischen Therapie, die chirurgische Strategie und das operative Verfahren für diese Indikationsstellung neu bestimmt werden. Anhand einer Literaturübersicht wird eine aktuelle Standortbestimmung des chirurgischen Therapiekonzeptes beim renalen Hyperparathyreoidismus vorgenommen und Einflüsse der neuen medikamentösen The­rapien aufgezeigt. Die verschiedenen Opera­tions­verfahren werden beschrieben und nach den ­aktuellen Indikationskriterien eingeordnet. Zusammenfassend zeigen sich der Zeitpunkt und die Indikationsstellung für chirurgische Maßnahmen durch die Kalzimimetika beeinflusst, die Operation der Nebenschilddrüsen bleibt jedoch weiterhin die einzige dauerhaft wirksame Therapie des renalen Hyperparathyreoidismus. 

Abstract

Conservative management of renal hyperparathyroidism has changed recently. Innovative substances, especially the advent of calcimimetics, have influenced the therapeutic concept. Consequently, a decline in surgical frequency for renal hyperparathyroidism has been reported. In this context it is now mandatory to evaluate the role of surgery, the surgical strategy and procedures for renal hyperparathyroidism anew. Based on a review of the literature the current position of surgical indications and care for renal hyperparathyroidism as well as possible influences of innovative medical treatment are highlighted. In summary, the timing and indications for surgery have been influenced, however, surgery still remains the only permanently effective treatment option for renal hyperparathyroidism. 

Schlüsselwörter

endokrine Chirurgie - renaler Hyper­parathyreoidismus - Kalzimimetika

Key words

endocrine surgery - renal hyperparathyroidism - calcimimetics

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